Provider Demographics
NPI:1831174002
Name:JOLLEYWATSON, DEBORAH K (DPH)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:K
Last Name:JOLLEYWATSON
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 HAYNES HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-4118
Mailing Address - Country:US
Mailing Address - Phone:931-968-0001
Mailing Address - Fax:
Practice Address - Street 1:131 HAYNES HOLLOW RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-4118
Practice Address - Country:US
Practice Address - Phone:931-968-0001
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC6329174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist